Individual
ALYSSA LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1720 N SPRUCE ST, OGALLALA, NE 69153-3307
(308) 284-4068
Mailing address
1825 ROAD EAST 120, PAXTON, NE 69155-3713
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1155
NE
Other
Enumeration date
03/25/2013
Last updated
03/25/2013
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